Fluid-driven tissue resecting instruments, systems, and methods

ABSTRACT

A tissue resecting instrument includes a housing, a shaft rotatable relative to the housing and defining a proximal end portion disposed within the housing and a distal end portion distally-spaced from the housing, a cutting member operably associated with the distal end portion of the shaft, a turbine disposed within the housing and operably associated with the proximal end portion of the shaft, and a fluid outflow tube operably associated with the housing. The fluid outflow tube is adapted to connect to a suction source to enable the suctioning of fluid and resected tissue proximally through a lumen of the shaft, an interior of the housing, and into the fluid outflow tube. The turbine is configured such that proximal fluid flow across the plurality of fins of the turbine urges the turbine to rotate, thereby rotating the shaft relative to the housing to enable tissue resection with the cutting member.

CROSS REFERENCE TO RELATED APPLICATION

The present application claims the benefit of and priority to U.S.Provisional Application Ser. No. 62/465,907, filed on Mar. 2, 2017 theentire contents of which are incorporated herein by reference.

BACKGROUND 1. Technical Field

The present disclosure relates generally to the field of tissueresection. In particular, the present disclosure relates to fluid-driventissue resecting instruments, systems, and methods.

2. Background of Related Art

Tissue resection may be performed endoscopically within an organ, suchas a uterus, by inserting an endoscope into the uterus and passing atissue resection device through the endoscope and into the uterus. Withrespect to such endoscopic tissue resection procedures, it often isdesirable to distend the uterus with a fluid, for example, saline,sorbitol, or glycine. The inflow and outflow of the fluid during theprocedure maintains the uterus in a distended state and flushes tissueand other debris from within the uterus to maintain a visible workingspace.

If the outflow of fluid from the uterus is greater than the inflow offluid, the uterus may collapse, making visualization and tissueresection difficult. On the other hand, if the inflow of fluid isgreater than the outflow of fluid, excess fluid can enter the patient'svascular system and result in serious complications or death. Thus, theinflow and outflow of fluid to/from the uterus is controlled to maintainproper distension of the uterus during the tissue resection procedure.This may be accomplished utilizing using a fluid pump (to pump theinflow flow) and/or fluid suction source (to suction the outflow fluid)in connection with one or more valves, switches, and/or other regulatingdevices.

In addition to the fluid pumps, fluid suction sources, valves, and/orother regulating devices utilized to maintain appropriate fluid inflowand fluid outflow, tissue resecting instruments and systems typicallyemploy a separate motor to drive the cutter of the tissue resectinginstrument to resect tissue.

SUMMARY

As used herein, the term “distal” refers to the portion that isdescribed which is further from a user, while the term “proximal” refersto the portion that is described which is closer to a user. Further, tothe extent consistent, any or all of the aspects described herein may beused in conjunction with any or all of the other aspects describedherein.

Provided in accordance with aspects of the present disclosure is atissue resecting instrument including a housing defining an interior, ashaft, a cutting member, a turbine, and a fluid outflow tube. The shaftis rotatable relative to the housing and extends distally from thehousing. The shaft defines a proximal end portion disposed within theinterior of the housing, a distal end portion distally-spaced from thehousing, and a lumen extending therethrough that is disposed in fluidcommunication with the interior of the housing. The cutting member isoperably associated with the distal end portion of the shaft to enabletissue resection upon rotation of the shaft. The turbine is disposedwithin the interior of the housing and operably associated with theproximal end portion of the shaft such that rotation of the turbinerotates the shaft relative to the housing. The turbine includes aplurality of fins. The fluid outflow tube is operably associated withthe housing and adapted to connect to a suction source to enable thesuctioning of fluid and resected tissue proximally through the lumen ofthe shaft, the interior of the housing, and into the fluid outflow tube.The turbine is configured such that proximal fluid flow across theplurality of fins of the turbine urges the turbine to rotate, therebyrotating the shaft relative to the housing to enable tissue resectionwith the cutting member.

In an aspect of the present disclosure, the cutting member is fixedlyengaged to the shaft such that rotation of the shaft rotates the cuttingmember to resect tissue therewith.

In another aspect of the present disclosure, a fixed outer tube isdisposed about the shaft. The fixed outer tube is fixed relative to andextends distally from the housing. The shaft is rotatable relative tothe fixed outer tube to enable tissue resection with the cutting member.

In yet another aspect of the present disclosure, the turbine includes atubular body disposed about the proximal end portion of the shaft. Thefins of the turbine are arranged annularly about the tubular body andextend radially outwardly therefrom.

In still another aspect of the present disclosure, the turbine includesa conical body disposed about the proximal end portion of the shaft andoriented such that a nose end of the conical body is disposedmore-distally and a base end of the conical body is disposedmore-proximally. The fins of the turbine are arranged about the conicalbody and extend radially outwardly therefrom.

In still yet another aspect of the present disclosure, the proximal endportion of the shaft defines a plurality of openings therethrough thatenable fluid communication between the lumen of the shaft and theinterior of the housing.

In another aspect of the present disclosure, the cutting member definesan opening therethrough in communication with the lumen of the shaft.The cutting member further includes a tissue cutting edge surroundingthe opening.

In yet another aspect of the present disclosure, the turbine includes athrust coupling that couples the turbine to the proximal end portion ofthe shaft.

A tissue resecting system provided in accordance with aspects of thepresent disclosure includes a tissue resecting instrument, an outersheath, a fluid pump, and a fluid suction source. The tissue resectinginstrument includes a housing, a shaft extending distally from thehousing, a cutting member operably associated with a distal end portionof the shaft, and a turbine disposed within the housing and operablyassociated with the cutting member such that rotation of the turbinerotates the cutting member relative to the housing to enable resectionof tissue. The outer sheath is disposed about the shaft so as to definean annular channel between the shaft and the outer sheath. The fluidpump is configured to pump fluid distally through the annular channeland into an internal surgical site. The fluid suction source isconfigured to suction fluid proximally out of an internal surgical site,through the shaft, and proximally across the turbine within the housing.The proximal fluid flow across the turbine urges the turbine to rotate,thereby rotating the cutting member relative to the housing to enabletissue resection with the cutting member.

In an aspect of the present disclosure, the cutting member is fixedlyengaged to the distal end portion of the shaft and the turbine isrotationally fixed to a proximal end portion of the shaft such thatrotation of the turbine rotates the shaft to thereby rotate the cuttingmember. In such aspects, the turbine may include a thrust coupling thatcouples the turbine to the proximal end portion of the shaft.

In another aspect of the present disclosure, a fixed outer tube isdisposed about the shaft. In such aspects, the outer sheath is disposedabout the fixed outer tube and the annular channel defined between theshaft and the outer sheath. The fixed outer tube is fixed relative tothe housing and the cutting member is rotatable relative to the fixedouter tube.

In still another aspect of the present disclosure, the system furtherincludes a fluid inflow tube coupling the fluid pump with the annularchannel and a fluid outflow tube coupling the housing with the fluidsuction source.

In yet another aspect of the present disclosure, the turbine includes atubular body and a plurality of fins arranged annularly about thetubular body and extending radially outwardly therefrom.

In still yet another aspect of the present disclosure, the turbineincludes a conical body oriented such that a nose end of the conicalbody is disposed more-distally and a base end of the conical body isdisposed more-proximally. The turbine further includes a plurality offins arranged about the conical body and extending radially outwardlytherefrom.

In another aspect of the present disclosure, the system further includesa fluid supply reservoir operably associated with the fluid pump and afluid collection reservoir operably associated with the fluid suctionsource.

A method of resecting tissue provided in accordance with aspects of thepresent disclosure includes positioning a tissue resecting instrumentsuch that a cutting member of the tissue resecting instrument isdisposed within an internal surgical site adjacent tissue to beresected. The tissue resecting instrument includes a turbine operablyassociated with the cutting member. The turbine is disposed within anoutflow path of the tissue resecting instrument. The method furtherincludes pumping fluid distally into the internal surgical site andsuctioning fluid proximally out of the internal surgical site throughthe outflow path of the tissue resecting instrument. Proximal fluid flowacross the turbine urges the turbine to rotate, thereby rotating thecutting member to resect tissue adjacent thereto.

In an aspect of the present disclosure, suctioning fluid proximallysuctions tissue into the cutting member such that the rotation of thecutting member resects tissue disposed therein, the resected tissuesuctioned though the outflow path of the tissue resecting instrumentalong with fluid.

In another aspect of the present disclosure, pumping fluid distallyincludes pumping fluid distally through an annular channel definedbetween a shaft of the tissue resecting instrument and an outer sheathdisposed about the shaft.

In another aspect of the present disclosure, pumping fluid distallyincludes pumping fluid from a fluid supply reservoir distally into theinternal surgical site, and/or suctioning fluid proximally includessuctioning fluid proximally out of the internal surgical site throughthe outflow path of the tissue resecting instrument to a fluidcollection reservoir.

BRIEF DESCRIPTION OF THE DRAWINGS

Various aspects and features of the present disclosure are describedhereinbelow with reference to the drawings wherein like numeralsdesignate identical or corresponding elements in each of the severalviews and:

FIG. 1 is a front, perspective view of a tissue resecting system providein accordance with aspects of the present disclosure;

FIG. 2 is an exploded, front, perspective view of the tissue resectinginstrument and outer sheath of the tissue resecting system of FIG. 1;

FIG. 3A is a side view of the distal end portion of the tissue resectingsystem of

FIG. 1;

FIGS. 3B-3D are side views of other distal end portion configurationsfor use with the tissue resecting system of FIG. 1;

FIG. 4 is a longitudinal, cross-sectional view of the proximal endportion of the tissue resecting instrument of the tissue resectingsystem of FIG. 1;

FIG. 5A is a front view of the turbine of the drive mechanism of thetissue resecting instrument of the tissue resecting system of FIG. 1;

FIG. 5B is a side view of another turbine configured for use with thetissue resecting instrument of the tissue resecting system of FIG. 1;

FIG. 5C is a front view of another turbine configured for use with thetissue resecting instrument of the tissue resecting system of FIG. 1;and

FIG. 6 is a side view of the tissue resecting system of FIG. 1 shownpositioned within a uterus for resecting tissue therefrom.

DETAILED DESCRIPTION

Referring to FIGS. 1 and 2, a tissue resecting system 10 provided inaccordance with the present disclosure includes a tissue resectinginstrument 100, an outer assembly 200 configured to removably couple totissue resecting instrument 100 (although, in embodiments, outerassembly 200 may be integral with tissue resecting instrument 100), afluid pump 300 including a fluid supply reservoir 310 associatedtherewith, and a suction source 400 including a fluid collectingreservoir 410 associated therewith. Tissue resecting system 10 may beused in conjunction with a suitable endoscope (not shown) or may be usedindependently thereof. As detailed below, tissue resecting system 10 isconfigured to facilitate the resection of tissue from within an internalbody cavity or organ, e.g., a uterus, while enabling fluid inflow andfluid outflow to maintain proper distension of the uterus during thetissue resection procedure, flush tissue and other debris from withinthe uterus, and maintain a visible working space.

Tissue resecting instrument 100 of tissue resecting system 10 generallyincludes a housing 110, an outer sheath connector 120, a shaft 130, acutting member 140, a drive mechanism 150, and a fluid outflow tube 160.Housing 110 defines a body portion 112 and a distal nose portion 114.Outer sheath connector 120 is disposed on distal nose portion 114 ofhousing 110 and includes a collar 122 having a plurality of engagementfeatures, e.g., radially-spaced male bayonet connectors 124 extendingradially outwardly from collar 122. As detailed below, outer sheathconnector 120 is configured to facilitate releasable engagement of outerassembly 200 with tissue resecting instrument 10. Fluid outflow tube 160communicates with the interior of housing 110 and/or the interior ofshaft 130 to enable the withdrawal, e.g., via suction, of fluid, tissue,and other debris from within housing 110 and/or shaft 130. Fluid outflowtube 160 is operably coupled to suction source 400 to enable suctiontherethrough and for depositing the suctioned fluid, tissue, and otherdebris into fluid collecting reservoir 410. Fluid outflow tube 160 mayfurther include a valve 170 associated therewith for regulating theoutflow of fluid from housing 110 and/or shaft 130.

Shaft 130 of tissue resecting instrument 100 defines a proximal endportion 132 and a distal end portion 134 and is rotatably coupled tohousing 110 to enable rotation of shaft 130 relative to housing 110about a longitudinal axis of shaft 130. Proximal end portion 132 ofshaft 130 is disposed within housing 110. Shaft 130 extends distallyfrom housing 110 through outer sheath connector 120 to distal endportion 134 of shaft 130. Cutting member 140, described in greaterdetail below, is fixed relative to and extends distally from distal endportion 134 of shaft 130. Drive mechanism 150 is operably supportedwithin body portion 112 of housing 110 and operably coupled to proximalend portion 132 of shaft 130. As also detailed below, drive mechanism150 is configured to drive rotation of shaft 130 relative to housing110, thus rotating cutting member 140 relative to housing 110 to resecttissue.

Continuing with reference to FIGS. 1 and 2, outer assembly 200 includesa proximal hub 210, an outer sheath 220, a fluid inflow tube 230, and avalve 240. Proximal hub 210 is configured for positioning about collar122 of outer sheath connector 120 of tissue resecting instrument 100 andincludes suitable engagement features, e.g., female bayonet connectors(not shown), to enable releasable engagement of proximal hub 210 aboutouter sheath connector 120 and, thus, releasable engagement of outerassembly 200 about tissue resecting instrument 100. Outer sheath 220 isfixed relative to and extends distally from proximal hub 210. Uponengagement of outer assembly 200 about tissue resecting instrument 100,outer sheath 220 of outer assembly 200 is disposed about shaft 130 oftissue resecting instrument 100 so as to define an annular channel 222(FIG. 3A) between shaft 130 and outer sheath 220. Fluid inflow tube 230of outer assembly 200 is operably and, in some embodiments, releasably,coupled to proximal hub 210 with valve 240 disposed therebetween toenable fluid to be pumped from fluid supply reservoir 310 into proximalhub 210 and through annular channel 222 (FIG. 3A) by way of fluid pump300.

With additional reference to FIG. 3A, cutting member 140 of tissueresecting instrument 100 defines an opening 142 providing access to theinterior of shaft 130 and a serrated edge 144 surround opening 142,although other suitable cutting edge configurations are alsocontemplated. In use, inflow fluid is pumped into the surgical sitethrough annular channel 222, as indicated by arrows “A” and outflowfluid is suctioned, along with tissue and other debris, into opening 142of cutting member 140 and through shaft 130, as indicated by arrows “B.”The suctioning of tissue into opening 142, in combination with therotation imparted to cutting member 140 by drive mechanism 150 (FIG. 2),enables the resection of tissue using serrated edge 144 and thesuctioning of the resected tissue proximally through shaft 130. Othersuitable configurations of the distal end portion of tissue resectinginstrument 100 to facilitate tissue resection and suctioning of theresected tissue proximally through tissue resecting instrument 100 arealso contemplated such as, for example, those detailed below withreference to FIGS. 3B-3D.

Referring to FIG. 3B, another configuration of the distal end portion oftissue resecting instrument 100 (FIG. 1) is provided wherein shaft 530includes a cutting member 540 extending distally therefrom, and whereina fixed outer tube 550 is disposed about shaft 530 and cutting member540. Alternatively, outer tube 550 may be rotatable and shaft 530 fixed,or outer tube 550 and shaft 530 may be rotatable in opposite directionsrelative to one another. Fixed outer tube 550 is fixedly secured tohousing 110 (FIG. 1) and defines an opening 552 extending through a sidewall thereof towards closed distal end 554 thereof. Opening 552 providesaccess to cutting member 540 within the interior of outer tube 550.

Cutting member 540 defines an opening 542 providing access to theinterior of shaft 530 and a serrated edge 544 surrounding opening 542,although other suitable cutting edge configurations are alsocontemplated. In use, inflow fluid is pumped into the surgical sitethrough annular channel 522 defined between outer sheath 520 and fixedouter tube 550, as indicated by arrows “A,” and outflow fluid issuctioned, along with tissue and other debris, through opening 552 ofouter tube 550 and into opening 542 of cutting member 540, as indicatedby arrows “B.” The suctioning of tissue into opening 542 of cuttingmember 540, in combination with the rotation of cutting member 540relative to outer tube 550, enables the resection of tissue usingserrated edge 544 and the suctioning of the resected tissue proximallythrough shaft 530, along with the outflow fluid and other debris.

FIG. 3C illustrates another configuration of the distal end portion oftissue resecting instrument 100 (FIG. 1), wherein shaft 630 includes acutting member 640 extending distally therefrom, and wherein a fixedouter tube 650 is disposed about shaft 630 and cutting member 640.Alternatively, outer tube 640 may be rotatable and shaft 630 fixed, orouter tube 650 and shaft 630 may be rotatable in opposite directionsrelative to one another. Fixed outer tube 650 is fixedly secured tohousing 110 (FIG. 1) and defines an open distal end 652 and a serratedannular distal edge 654 surrounding open distal end 652.

Cutting member 640 defines an open distal end 642 and a serrated annulardistal edge 644 surrounding open distal end 642. Serrated annular distaledge 644 of cutting member 640 is positioned in close proximity toserrated annular distal edge 654 of outer tube 650 and, in someembodiments, is positioned such that the serrations on serrated annulardistal edge 644 and the serrations on serrated annular distal edge 654at least partially overlap one another. In use, inflow fluid is pumpedinto the surgical site through annular channel 622 defined between outersheath 620 and fixed outer tube 650, as indicated by arrows “A,” andoutflow fluid is suctioned, along with tissue and other debris, throughopenings 652, 642 of outer tube 650 and cutting member 640,respectively, as indicated by arrows “B.” The suctioning of tissue intoopening 642 of cutting member 640, in combination with the rotation ofcutting member 640 relative to outer tube 650, enables the resection oftissue using serrated edges 644, 654 and the suctioning of the resectedtissue proximally through shaft 630, along with the outflow fluid andother debris.

With reference to FIG. 3D, another configuration of the distal endportion of tissue resecting instrument 100 (FIG. 1) is provided, whereinshaft 730 includes a cutting member 740 extending distally therefrom,and wherein a fixed outer tube 750 is disposed about shaft 730 andcutting member 740. Alternatively, outer tube 750 may be rotatable andshaft 730 fixed, or outer tube 750 and shaft 730 may be rotatable inopposite directions relative to one another. Fixed outer tube 750 isfixedly secured to housing 110 (FIG. 1) and defines an open distal end752 and a beveled distal edge 754 surrounding open distal end 752.Beveled distal edge 754 may be sharpened so as to serve as a cuttingedge, or may be blunt.

Cutting member 740 defines an open distal end 742 and an annular distaledge 744 surrounding open distal end 742. Annular distal edge 744 may besharpened so as to serve as a cutting edge, or may be blunt. Cuttingmember 740 extends partially from outer tube 740 such that annulardistal edge 744 is exposed towards one side of beveled distal edge 754of outer tube 750 but is recessed within beveled distal edge 754 ofouter tube 750 towards the other side thereof. In use, inflow fluid ispumped into the surgical site through annular channel 722 definedbetween outer sheath 720 and outer tube 750, as indicated by arrows “A,”and outflow fluid is suctioned, along with tissue and other debris,through openings 752, 742 of outer tube 750 and cutting member 740,respectively, as indicated by arrows “B.” The suctioning of tissue intoopening 742 of cutting member 740, in combination with the rotation ofcutting member 740 relative to outer tube 750, enables the resection oftissue using annular distal edge 744 and/or beveled distal edge 754 andthe suctioning of the resected tissue proximally through shaft 730,along with the outflow fluid and other debris.

Turning to FIGS. 3A, 4, and 5A, as noted above, tissue resectinginstrument 100 includes drive mechanism 150 which is operably supportedwithin housing 110 and operably coupled to proximal end portion 132 ofshaft 130. Drive mechanism 150, more specifically, includes a turbine152 and a thrust coupling 154. Turbine 152, in some embodiments,includes a tubular body 156 and a plurality of propeller blade-like fins158. Tubular body 156 is disposed about proximal end portion 132 ofshaft 130 within housing 110, while the plurality of fins 158 areengaged to, annularly spaced about, and extend radially outwardly fromtubular body 156 within housing 110. Fins 158 are configured such thatthe flow of the outflow fluid proximally through housing 110, asindicated by arrows “P,” urges fins 158 to rotate, as indicated byarrows “R,” thereby similarly rotating tubular body 156. Other suitableturbine configurations are also contemplated such as, for example, thosedetailed below with reference to FIGS. 5B and 5C.

Thrust coupling 154 couples tubular body 156 with proximal end portion132 of shaft 130 such that rotation of tubular body 156 effects rotationof shaft 130 and, thus, cutting member 140 (FIG. 3A), about itslongitudinal axis, as indicated by arrows “R.” Thrust coupling 154, morespecifically, includes a transverse pin 159 a extending transverselythrough proximal end portion 132 of shaft 130 and outwardly from eitherside thereof. The ends of transverse pin 159 a extend through opposedlongitudinal slots 159 b defined within tubular body 156 of turbine 152and are received within an annular track 116 defined on an interiorsurface of housing 110. Receipt of transverse pin 159 a within annulartrack 116 inhibits translation of transverse pin 159 a and, thus, shaft130 relative to housing 110 while permitting rotation of transverse pin159 a and shaft 130 relative to housing 110. With transverse pin 159 aextending through opposed longitudinal slots 159 b of tubular body 156of turbine 152, turbine 152 is confined to a small amount of translationrelative to shaft 130 and housing 110, e.g., as defined by the length oflongitudinal slots 159 b, to provide some play therebetween and absorbaxial load imparted thereto. Further, with transverse pin 159 aextending through proximal end portion 132 of shaft 130 and opposedlongitudinal slots 159 b of tubular body 156 of turbine 152, transversepin 159 a serves to engage shaft 130 and turbine 152 with one anothersuch that rotation of turbine 152 effects corresponding rotation ofshaft 130. One or more biasing members (not shown) may further beprovided to bias transverse pin 159 a towards a particular positionwithin longitudinal slots 159 b. Other suitable thrust couplings, e.g.,thrust bearings, configured to enable rotation while also supportingaxial load are also contemplated. Alternatively, rather than providing athrust coupling, tubular body 156 may be rigidly coupled to proximal endportion 132 of shaft 130.

Referring to FIG. 5B, another turbine configured for use with tissueresecting instrument 100 (FIG. 1) is identified by reference numeral852. Turbine 852 includes a conical body 856 and a plurality ofelongated fins 858. Turbine 852 may be coupled to proximal end portion132 of shaft 130 within housing 110 (see FIG. 4) via a thrust couplingor via a rigid connection. In use with tissue resecting instrument 100(FIG. 1), conical body 856 of turbine 852 is oriented such that nose 857a of conical body 856 is more-distally disposed, while base 857 b ofconical body 856 is more-proximally disposed. Fins 858 are engaged to,spaced about, and extend longitudinal along and outwardly from conicalbody 856. Fins 858 are configured such that the flow of the outflowfluid proximally through housing 110, as indicated by arrows “P” (seeFIG. 4), urges fins 858 to rotate, as indicated by arrows “R” (see FIG.4), thereby similarly rotating tubular body 856.

FIG. 5C illustrates another turbine configured for use with tissueresecting instrument 100 (FIG. 1) identified by reference numeral 952.Turbine 952 includes a tubular body 956 and a plurality of overlappingjet engine blade-like fins 958. Turbine 952 may be coupled to proximalend portion 132 of shaft 130 within housing 110 (see FIG. 4) via athrust coupling or via a rigid connection. Fins 958 are engaged to andannularly disposed about conical body 956 in overlapping relationrelative to one another. Fins 958 are configured such that the flow ofthe outflow fluid proximally through housing 110, as indicated by arrows“P” (see FIG. 4), urges fins 958 to rotate, as indicated by arrows “R”(see FIG. 4), thereby similarly rotating tubular body 956.

Referring to FIGS. 1, 2, and 6, in use, tissue resecting instrument 100,with outer assembly 200 disposed thereon, is positioned within aninternal body cavity or organ, e.g., a uterus “U.” Once positioned inthis manner, fluid pump 300 is activated to pump inflow fluid from fluidsupply reservoir 310 into the uterus “U” to distend the uterus “U.”Suction source 400 is also activated, to suction fluid from the uterus“U” through tissue resecting instrument 100 and into fluid collectingreservoir 410. The pumping of inflow fluid and suctioning of outflowfluid may continue simultaneously throughout the procedure in order toachieve continuous flow during the procedure.

With additional reference to FIG. 4, as noted above, the outflow fluidflows proximally through tissue resecting instrument 100 under suctionfrom suction source 400. More specifically, suction source 400 suctionsthe outflow fluid into opening 142 of cutting member 140 and throughshaft 130. The outflow fluid is suctioned proximally through shaft 130and enters housing 110 via a plurality of openings 136 defined withinshaft 130 towards proximal end portion 132 thereof. The outflow fluid isfurther suctioned proximally through housing 110 and into fluid outflowtube 160, through which the outflow fluid travels to fluid collectingreservoir 410.

The suction force provided by suction source 400 to suction the outflowfluid into cutting member 140 and proximally through housing 110establishes sufficient fluid flow through housing 110 and proximallyacross fins 158 of turbine 152 to urge turbine 152 to rotate, therebyrotating shaft 130 and cutting member 140. With cutting member 140rotating and suction source 400 suctioning tissue into cutting member140, tissue is resected and removed from the uterus “U” through tissueresecting instrument 100. Thus, rather than the need for a separatedrive source, e.g., a motor, for driving rotation of cutting member 140,cutting member 140 is driven by the proximal flow of outflow fluid undersuction.

Although resected tissue and other debris are also suctioned intocutting member 140 and through shaft 130, housing 110, fluid outflowtube 160, and into fluid collecting reservoir 410 (FIG. 1), the cuttingprovided by cutting member 140 creates sufficiently small pieces ofresected tissue and other debris so as not to interfere with turbine 152or alter the rotation imparted thereto by the proximally-flowing outflowfluid. Alternatively, filters (not shown) may be extend across openings136 such that only fluid exits openings 136 of shaft 130 and flowsproximally over fins 158 of turbine 152, while the resected tissue andother debris are suctioned proximally through the open proximal end ofshaft 130, housing 110, and into fluid outflow tube 160, thus bypassingturbine 152.

Referring again to FIG. 6, once tissue is resected and removed, fluidpump 300 and suction source 400 may be deactivated and tissue resectinginstrument 100, together with outer assembly 200, removed from theuterus “U.”

While several embodiments of the disclosure have been shown in thedrawings, it is not intended that the disclosure be limited thereto, asit is intended that the disclosure be as broad in scope as the art willallow and that the specification be read likewise. Therefore, the abovedescription should not be construed as limiting, but merely as examplesof particular embodiments. Those skilled in the art will envision othermodifications within the scope and spirit of the claims appended hereto.

Although the foregoing disclosure has been described in some detail byway of illustration and example, for purposes of clarity orunderstanding, it will be obvious that certain changes and modificationsmay be practiced within the scope of the appended claims.

What is claimed is:
 1. A tissue resecting instrument, comprising: ahousing defining an interior; a shaft rotatable relative to the housingand extending distally from the housing, the shaft defining a proximalend portion disposed within the interior of the housing, a distal endportion distally-spaced from the housing, and a lumen extendingtherethrough, the lumen disposed in fluid communication with theinterior of the housing; a cutting member operably associated with thedistal end portion of the shaft to enable tissue resection upon rotationof the shaft; a turbine disposed within the interior of the housing andoperably associated with the proximal end portion of the shaft such thatrotation of the turbine rotates the shaft relative to the housing, theturbine including a plurality of fins; a fluid outflow tube operablyassociated with the housing, the fluid outflow tube adapted to connectto a suction source to enable the suctioning of fluid and resectedtissue proximally through the lumen of the shaft, the interior of thehousing, and into the fluid outflow tube; and a hole formed in the shaftat a position distal to the turbine, the hole forming a fluid path toallow fluid to flow from within the shaft to the plurality of fins ofthe turbine, wherein the turbine is configured such that proximal fluidflow across the plurality of fins of the turbine urges the turbine torotate, thereby rotating the shaft relative to the housing to enabletissue resection with the cutting member.
 2. The tissue resectinginstrument according to claim 1, wherein the cutting member is fixedlyengaged to the shaft such that rotation of the shaft rotates the cuttingmember to resect tissue therewith.
 3. The tissue resecting instrumentaccording to claim 1, further comprising a fixed outer tube disposedabout the shaft, the fixed outer tube fixed relative to and extendingdistally from the housing, the shaft rotatable relative to the fixedouter tube to enable tissue resection with the cutting member.
 4. Thetissue resecting instrument according to claim 1, wherein the turbineincludes a tubular body disposed about the proximal end portion of theshaft, and wherein the fins are arranged annularly about the tubularbody and extends radially outwardly therefrom.
 5. The tissue resectinginstrument according to claim 1, wherein the turbine includes a conicalbody disposed about the proximal end portion of the shaft and orientedsuch that a nose end of the conical body is disposed more-distally and abase end of the conical body is disposed more-proximally, and whereinthe fins are arranged about the conical body and extend radiallyoutwardly therefrom.
 6. The tissue resecting instrument according toclaim 1, wherein the hole is on the proximal end portion of the shaftand comprises a plurality of holes therethrough that enable fluidcommunication between the lumen of the shaft and the interior of thehousing.
 7. The tissue resecting instrument according to claim 1,wherein the cutting member defines an opening therethrough incommunication with the lumen of the shaft, and includes a tissue cuttingedge surrounding the opening.
 8. The tissue resecting instrumentaccording to claim 1, wherein the turbine includes a thrust couplingthat couples the turbine to the proximal end portion of the shaft.
 9. Atissue resecting system, comprising: a tissue resecting instrumentincluding a housing, a shaft extending distally from the housing, acutting member operably associated with a distal end portion of theshaft, and a turbine disposed within the housing and operably associatedwith the cutting member such that rotation of the turbine rotates thecutting member relative to the housing to enable resection of tissue; anouter sheath disposed about the shaft, wherein an annular channel isdefined between the shaft and the outer sheath; a fluid pump configuredto pump fluid distally through the annular channel and into an internalsurgical site; a fluid suction source configured to suction fluidproximally out of an internal surgical site, through the shaft, andproximally across the turbine within the housing; and a hole formed inthe shaft at a position distal to the turbine, the hole forming a fluidpath to allow fluid to flow from within the shaft to the turbine,wherein proximal fluid flow across the turbine urges the turbine torotate, thereby rotating the cutting member relative to the housing toenable tissue resection with the cutting member.
 10. The tissueresecting system according to claim 9, wherein the cutting member isfixedly engaged to the distal end portion of the shaft, and wherein theturbine is rotationally fixed to a proximal end portion of the shaftsuch that rotation of the turbine rotates the shaft to thereby rotatethe cutting member.
 11. The tissue resecting system according to claim10, wherein the turbine includes a thrust coupling that couples theturbine to the proximal end portion of the shaft.
 12. The tissueresecting system according to claim 9, further comprising a fixed outertube disposed about the shaft, the outer sheath disposed about the fixedouter tube and the annular channel defined between the shaft and theouter sheath, wherein the fixed outer tube is fixed relative to thehousing, and wherein the cutting member is rotatable relative to thefixed outer tube.
 13. The tissue resecting system according to claim 9,further comprising: a fluid inflow tube coupling the fluid pump with theannular channel; and a fluid outflow tube coupling the housing with thefluid suction source.
 14. The tissue resecting system according to claim9, wherein the turbine includes a tubular body and a plurality of finsare arranged annularly about the tubular body and extending radiallyoutwardly therefrom.
 15. The tissue resecting system according to claim9, wherein the turbine includes a conical body oriented such that a noseend of the conical body is disposed more-distally and a base end of theconical body is disposed more-proximally, the turbine further includinga plurality of fins are arranged about the conical body and extendingradially outwardly therefrom.
 16. The tissue resecting system accordingto claim 9, further comprising: a fluid supply reservoir operablyassociated with the fluid pump; and a fluid collection reservoiroperably associated with the fluid suction source.